2023 Temporary Employee Benefits Guide - AustinTexas.gov
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2023 Temporary Employee Benefits Guide Medical | Wellness | Employee Assistance Program Commuter Program | Deferred Compensation The City of Austin is committed to compliance with the Americans with Disabilities Act. Call the Human Resources Department at 512-974-3400 (Voice) or 800-735-2985 (Relay Texas TTY number) for more information.
Contact Information
City of Austin BlueCross BlueShield
Human Resources Department Medical Plans
Employee Benefits Division
Member Service Phone Number: 888-907-7880
Benefits staff are available to answer questions you have 24/7 NurseLine Phone Number: 800-581-0368
about your benefits. For your convenience, make an
Group Numbers: PPO - 246681; HMO - 246682; CDHP -
appointment before visiting our office.
246683; BlueCare Dental PPO – 299988
Phone Number: 512-974-3284 To view the prescription formulary, Explanation of Benefits,
Outlook Email: HRD, Benefits and print a temporary ID card, visit bcbstx.com/coa. To
Email: HRD.Benefits@austintexas.gov register, follow these steps:
Fax Number: 512-974-3420
1. Click Log in.
2. Click Register Now.
Office Hours: 7:30 a.m. to 5:00 p.m. 3. Follow the prompts to register.
Closed 12 – 1 p.m. 4. Enter information from your ID card. If you do not have
Location: 505 Barton Springs Road, Suite 600 your ID card, you can call the Internet Help Desk at
888-907-7880.
Online Resources
Resources are available at cityspace, the City’s intranet To find a medical provider, visit bcbstx.com/coa.
website, or on the Internet at austintexas.gov/benefits.
1. Click on Doctors and Hospitals tab.
CompuSys/Erisa Group Inc. (Erisa) 2. Under Find a Provider, click on HMO Plan, PPO Plan,
COBRA Administration or HSA Plan.
3. Click on Browse by Category and select the type of
These programs are managed by the City’s third medical care you are searching for: Medical Care, Urgent
party administrator, Erisa. Care Center, or Behavioral Health or Search for Names
and Specialties.
Phone Number: 512-250-9397
Toll-Free Number: 800-933-7472 ComPsych GuidanceResources
Fax Number: 512-250-2937
Employee Assistance Program
Austin Deferred Compensation Plan Toll-Free Phone Number: 866-586-1456
457 Plan (Empower Retirement)
To view a list of free webinars, counseling services and
Toll-Free Number: 866-613-6189 more visit guidanceresources.com. To access, follow
To enroll in, view and manage your account, go to these steps:
dcaustin.com, and click the Register button.
1. Click the Register tab.
2. Enter austintexas.gov as your Organization Web ID and
click the Register button.
3. Select your company, Organization, or Location
Identification.
4. Enter a user name and password.
5. Confirm security questions.
6. Click the Submit button.Benefits Guide Information
City of Austin Temporary employees have access to benefits approved by the City Council each year as part of the budget
process. The benefits and services offered by the City may be changed or end at any time. These benefits are not a guarantee
of employment with the City.
This Guide is designed to help you understand your benefits and assist you in making your enrollment decisions. Your rights
are overseen by each Plan. The terms of the Plan and detailed coverage information are included in the document made
available by the Plan, which may be a plan document, evidence of coverage, certificate of coverage, contract, etc.
In the case of a conflict between information presented in this Guide and the Plan, the Plan’s terms take over.
City Benefits A variety of methods are used to communicate the benefits
The City is concerned for the health, welfare, and safety of program to employees and their dependents, including
its employees and is committed to providing cost-effective, presentations, newsletters, the City’s website, video on
sustainable benefits that assist employees in being demand, and CityNews.
physically and mentally healthy. The benefits offered in this
document require employees to assume responsibility for In addition, benefits staff are available by phone or in person
the choices they make and to be informed on how to use
to discuss benefits questions with employees and their
their benefits effectively.
families. Communication goals of the benefits program
include:
The City will search for other areas of benefits to the degree
where they fill a need of a major portion of the workforce
and to the degree they can be provided cost-effectively and • Educating employees on how to use their benefits.
efficiently on a group basis. Employees should understand their responsibility
for the choices they make.
Administration and Cost-Wise Consumerism Employees should follow the requirements of the
plans.
The overall administration of the benefits program is re-
• Educating employees on how to be better users of
evaluated and revised periodically to ensure it is simple,
all benefits.
efficient, cost-effective, and satisfies overall goals. Since Employee choices should be appropriate for their
rising health care costs affect both the City and its needs.
employees, the City will continue to study new coverage Employees should contribute to the cost-effectiveness
options that help control health care costs. The program is of the plans by making informed choices when using
designed to be cost- effective, for both the short term and the their benefits. users
long term. • Increasing employee understanding of the value of
their benefits.
Employee contributions are required to help finance the cost
of parts of the program.
Employee Communications
The Human Resources Department publishes newsletters to
educate and inform employees about human resources-
related issues. It is important for employees to take time to
review these publications to avoid missing important
information.
• The HR Update is published quarterly for employees.
• CityNews is an online weekly newsletter published by the
Communications and Public Information Office. It focuses
on the people and projects that define the City of Austin
workforce and provides valuable information about City
benefits.Benefits Eligibility • Employee Eligibility • Dependent Eligibility • Persons Not Eligible • Dependent Documentation • Coverage Information
Temporary Employee Eligibility
Temporary employees and their eligible dependents can enroll in the City’s medical coverage based on the eligibility
requirements below:
• Worked for 12 consecutive months with the City.
• Over the age of 18
• Not a City retiree
Temporary employees that become eligible for coverage will receive written notification of eligibility from the Employee
Benefits Division within 2 to 4 weeks from their anniversary date.
Benefits Eligibility for Temporary Employees
• Medical
• Commuter Program
• Employee Assistance Program
• Deferred Compensation
• Wellness Program
Temporary employees are not eligible to earn ADL for a Health Assessment or for PE. They are eligible for all other
wellness program incentives including Healthy Rewards if enrolled in a City medical plan.
Work Week Status for Temporary Employees:
• The rates being offered to Temporary employees are the same as Regular employee rates.
• There are three categories of rates, which are based on the amount of hours worked each week:
30+ hours
20-29 hours
less than 20 hours
• It is important to understand that the category of rates are not determined by what the department has listed the
Temporary employee’s hours as in the payroll system.
• The category is determined by calculating the Temporary employees weekly hourly average based on the previous 52
weeks they have worked (26 full pay periods).
• The weekly hourly average will be evaluated on an annual basis every October prior to the annual Open Enrollment
period. If a Temporary employee’s weekly hourly average changes they will be sent notification of the change.Dependent Eligibility
Enrolling Dependents for Benefits
If you are a full-time or part-time employee, your dependents are eligible for:
• Medical
• Wellness Program
• Employee Assistance Program
Eligible Dependents
• Spouse: Your legally married spouse.
• Domestic Partner: The individual who lives in the same household and shares the common resources of life in a
close, personal, intimate relationship with a City employee if, under Texas law, the individual would not be prevented
from marrying the employee on account of age, consanguinity or prior undissolved marriage to another person. A
domestic partner may be of the same or opposite gender as the employee.
• Children: Your biological children, stepchildren, legally adopted children, children for whom you have obtained
court-ordered guardianship or conservatorship, qualified children placed pending adoption. Your children must
be under 26 years of age.
• Dependent Grandchildren: Your unmarried grandchild must meet the requirements listed above, and must also
qualify as a dependent (as defined by the Internal Revenue Service) on your or your spouse’s federal income tax
return.
• Disabled Children: To continue City coverage for an eligible dependent past the age limit, the child must be
covered as a dependent at the time, unmarried, and must also meet the following definitions:
A disabled child must rely on you for more than 50 percent of support.
A child is considered disabled if they are incapable of earning a living at the time the child would otherwise cease
to be a dependent and depend on you for principal support and maintenance, due to a mental or physical disability.
A disabled child continues to be considered an eligible dependent as long as the child remains incapacitated and
dependent on you for principal support and maintenance, and you continuously maintain the child’s coverage as a
dependent under the plan from the time they otherwise would lose dependent status.
A dependent child who loses eligibility and later becomes disabled is not eligible for coverage. A disabled child
who was not covered as a dependent immediately prior to the time the child would otherwise cease to be a
dependent is not eligible for coverage.
A disabled dependent must be covered continuously on the medical plan. If coverage is dropped on a plan, they
will not be allowed to re-enroll.Dependent Documentation
To provide coverage for a dependent under any of the City’s benefits programs, you must provide documentation that
supports your relationship to the dependent. Social Security Numbers must be provided for all eligible dependents.
Acceptable documents are listed below for the following dependents:
• Spouse: A marriage certificate which has been recorded as provided by law.
• Domestic Partner: A Domestic Partnership Affidavit and Agreement form signed by the employee and domestic
partner. Also a Domestic Partnership Tax Dependent Status Form signed by the employee.
• Child: A certified birth certificate, complimentary hospital birth certificate, Verification of Birth Facts issued by the
hospital or court order establishing legal adoption, guardianship, or conservatorship, or qualified medical child support
order or be the subject of an Administrative Writ.
• Child of a Domestic Partner: The documentation listed above must also be provided and the domestic partner must be
covered for the same benefit in order to cover a child of a domestic partner.
• Stepchild: The documentation listed above must also be provided and a marriage certificate or declaration of informal
marriage indicating the marriage of the child’s parent and stepparent.
• Dependent Grandchild: The documentation listed above must also be provided and a birth and/or marriage certificate
or declaration of informal marriage that supports the relationship between you and your grandchild.
• Disabled Child: A completed Dependent Eligibility Questionnaire verifying an ongoing total disability, including
written documentation from a physician verifying an ongoing total disability.
• Qualified Child Pending Adoption: For children already placed in your home, an agreement executed between you
and a licensed child-placing agency, or the Texas Department of Family and Protective Services, meeting the
requirements listed in Dependent Eligibility.
Persons Not Eligible
Dependents do not include:
• Individuals on active duty in any branch of military service (except to the extent and for the period required by law).
• Permanent residents of a country other than the United States.
• Parents, grandparents, or other extended family members not listed under the Eligible Dependents section.
• Grandchildren who do not meet the definition of dependent grandchildren or who are not claimed on your or your
spouse’s federal income tax return.Coverage Information
ENROLLING IN BENEFITS adoption, guardianship, or conservatorship of a child, the
Insurance Benefits for you and/or your dependents are benefits change is effective the date of the Qualifying
effective on your date of hire or work status change Life Event and you will be required to pay any benefits
provided you submitted a Benefits Enrollment Form and premiums owed, if applicable.
required documentation to the Employee Benefits Note: A newborn dependent is temporarily covered for
Division by the pay period deadline. If you missed the medical for 31 days. After 31 days, if you did not contact
deadline, you have 31 days from your date of hire or the Employee Benefits Division to enroll your newborn,
work status change to enroll in benefits by calling the your newborn will no longer have medical coverage even
Employee Benefits Division at 512-974-3284. Benefits if you have Employee and Children or Family coverage.
coverage will be effective the first day of the following
pay period from the date you submitted your Benefits DUPLICATE BENEFITS COVERAGE
Enrollment Form. An individual is not eligible to be covered:
• As both a City employee and a City retiree, for the
If you are a full-time or part-time employee declining same benefit.
benefits coverage for yourself, you must complete a • As both a City employee or City retiree and as a
Benefits Enrollment Form. If you later decide you want dependent of a City employee or City retiree, for the
coverage, you can enroll within 31 days due to a same benefit.
Qualifying Life Event or during Open Enrollment. • As a dependent of more than one City employee, or
City retiree, for the same benefit.
CHANGING YOUR BENEFITS COVERAGE
You can request changes to your benefits coverage: It is your responsibility to ensure that you and/or your
• Within 31 days of your date of hire or work status dependents are not double covered for the same benefit.
change. Duplicate claims will not be paid, and premiums will not
• Within 31 days of a Qualifying Life Event. be refunded.
• During Open Enrollment (occurs mid-October through
mid-November, benefits changes are effective January COVERAGE ENDING DATES
1 of the following year). Coverage for you and your dependents will end on the
earliest of the following:
To change your benefits coverage or to drop a dependent • Within 31 days of your date of hire or work status
who no longer meets the eligibility requirements, you change.
must contact the Employee Benefits Division to complete • The date the plan in question ends.
a Benefits Enrollment Form and provide the required • The date the coverage in question ended or is reduced.
documentation. • The date the plan is amended to end coverage for you
or your class of dependents.
QUALIFYING LIFE EVENTS • The last day of the pay period in which you voluntarily
You can add/drop dependents or change your benefits drop coverage.
coverage when you experience a Qualifying Life Event • The last day of the pay period in which your
such as: marriage, divorce, birth, adoption/placement of a employment ends.
child, death of a dependent, establishing a committed • The last day of the pay period in which you or your
living arrangement as domestic partners, dissolution of dependents no longer meet eligibility requirements.
domestic partnership, or loss or gain of other insurance
coverage. You must contact the Employee Benefits
Division within 31 days of the Qualifying Life Event to
complete a Benefits Enrollment Form and provide the
required documentation.
The benefits change will be effective the first day of the
following pay period, or the month following the date
you submitted your Benefits Enrollment Form. In the
case of a newborn dependent, adoption, placement ofPREMIUM INFORMATION For full or part-time (20-29 hours) employees, the City pays a portion of your dependent’s medical and dental premiums. The amount paid by the City is not taxable to you if your dependent is a qualified dependent as defined by the Internal Revenue Service (IRS). You are responsible for determining whether your dependent meets the IRS dependent definition. PREMIUM DEDUCTION ERRORS It is your responsibility to ensure that information on your Benefits Enrollment Form, your annual Open Enrollment Coverage Statement, and Confirmation Statement is correct. If a premium deduction error occurs, you must notify the Employee Benefits Division. If an overpayment occurs due to a City data entry error or an error you made when completing your enrollment form or participating in Open Enrollment, the City will reimburse you up to a maximum of two pay period premiums. Conversely, if an underpayment occurs due to the City data entry error or the error you made, the City has the right to collect any additional premiums owed. The data entry error will not invalidate the coverage reflected on your enrollment form. TAXABLE FRINGE If you choose benefits coverage for a dependent who does not qualify to be claimed on your federal income tax return, you may have to pay taxes on the amount of money the City contributes for the dependent’s medical and dental benefits. This money is considered taxable income, and must be reported to the IRS. The City refers to this money as taxable fringe. A spouse is never subject to taxable fringe. If at least one of the children for whom you have elected medical or dental coverage is a child you claim as a dependent on your federal income tax return, the City’s contribution will not be considered taxable income. RETIRING FROM THE CITY OF AUSTIN After you finalize your retirement paperwork with the retirement system, you must call the Employee Benefits Division within 31 days from your retirement date to enroll in retiree benefits. If you miss this deadline, your next opportunity to enroll will be during Open Enrollment or within 31 days of a Qualifying Life Event. To avoid a lapse in your benefits coverage (from active employee benefits to retiree benefits), you must call no later than the last day of the month you are retiring in.
Plan Choices
• Medical
CDHP w/HSA (Consumer Driven Health
Plan)
PPO (Preferred Provider Organization)
HMO (Health Maintenance Organization)CDHP w/HSA, PPO and
HMO Medical Plans
As an employee, you choose the medical plan that best meets your needs. Provider
and prescription information is available online at bcbstx.com/coa. /HSA and PPO.
Things to consider when choosing a medical plan:
• Premium costs for dependent coverage.
• Amount of copays.
• Amount of out-of-pocket expenses.
• Future expenses and the predictability of inpatient hospital expenses.
• Freedom to not designate a Primary Care Physician.
• Freedom to seek services from a Specialist without a referral.
BlueCross BlueShield Medical Rates – Per Pay Period
Full-Time Employees CDHP PPO HMO
30 + hours per week w/HSA
Employee Only $ 0.00 $ 15.00 $ 20.00
Employee & Spouse or Domestic Partner $ 96.37 $ 200.67 $ 210.67
Employee & Children $ 47.79 $ 147.84 $ 157.84
Employee & Family or Domestic Partner & Children $ 221.63 $ 336.91 $ 346.91
Part-Time Employees CDHP PPO HMO
20 - 29 hours per week w/HSA
Employee Only $ 138.08 $ 127.03 $ 132.03
Employee & Spouse or Domestic Partner $ 358.04 $ 428.08 $ 438.08
Employee & Children $ 288.22 $ 351.04 $ 361.04
Employee & Family or Domestic Partner & Children $ 537.27 $ 632.41 $ 642.41
Part-Time Employees CDHP PPO HMO
Less than 20 hours per week w/HSA
Employee Only $ 276.16 $ 357.03 $ 428.68
Employee & Spouse or Domestic Partner $ 619.71 $ 801.14 $ 978.96
Employee & Children $ 528.65 $ 684.21 $ 835.88
Employee & Family or Domestic Partner & Children $ 852.91 $1,102.63 $1,347.18CDHP w/HSA – Is it right for you?
Benefits of the CDHP w/HSA:
• No cost for Employee Only coverage and lower medical premiums if you cover dependents.
• Health Savings Account through HSA Bank established in your name with a HSA Bank debit card.
• City contribution into a Health Savings Account for Full-Time employees. If enrolling after July 1, 2023, City
contribution is reduced to half. Part-Time employees (20-29 hours) receive a reduced contribution.
$500 for Employee Only Coverage.
$1,000 for Employee & Dependent Coverage.
• Ability to contribute money on a pretax basis into a Health Savings Account.
$139 maximum per pay period for Employee Only coverage.
$281 maximum per pay period for Employee & Dependent coverage.
• Ability to increase or decrease your HSA per pay period contributions any time during the year.
• The money remaining in your HSA Account (including the City’s contribution) is yours to keep even if you leave
employment or retire from the City.
• 100% coverage for preventive services – such as annual physicals, well baby checks, well woman checks,
mammograms, and colonoscopies.
• Once you meet your calendar year deductible, the plan will pay 80% of Tier 1 providers covered services and 70% of
Network providers covered services.
• Affordable Care Act (ACA) Preventive Drug List – covered at 100%.
• CDHP w/HSA Preventive Drug List – No deductible. Plan pays 80% for medications for conditions such as heart
disease, high blood pressure, high cholesterol, and asthma.
• Basic Drug List (Tier 1, 2 & 3 Drugs) – Plan pays 80% after you have met your calendar year deductible. To reach your
deductible, you can pay your expenses with your HSA Bank debit card.
• Tier 1 and Network providers bill you for services after BlueCross BlueShield discounted rates.
• Use your HSA debit card to meet your deductible and pay for eligible medical, pharmacy, dental, and vision expenses.
The chart below highlights how much a family may save if enrolled in the CDHP compared to the HMO, based on a 30+
hour work week.
CDHP Medical Plan HMO Medical Plan
Employee & Family premiums $5,6319/yea Employee & Family premiums $8,325/year
Four primary care doctor visits $ 600/year Four primary care doctor visits $ 120/year
Four prescriptions $ 124/year Four prescriptions $ 40/year
Total employee paid for the year $4,595 Total paid medical expenses for the $8,165
City's HSA contribution $1,000 City's HSA contribution No City contribution
Net paid medical expenses for the $3,595 Net paid medical expenses for the $8,165
A savings of $4,590CDHP Health Savings Account Eligibility:
To be eligible to participate in the HSA, you must meet requirements below as determined by the IRS. If all requirements
are not met, you and/or your dependents are not eligible to participate in a HSA. However, you and/or your dependents are
eligible to enroll in the CDHP Medical Plan.
• You or your enrolled dependents cannot be claimed on another person’s tax return.
• You cannot be enrolled in any plan other than a high-deductible plan including: Medicare, Medicaid, and Tricare.
• You or your enrolled dependents cannot be enrolled in Health Care FSA.
• You must provide a physical address to HSA Bank (no post office boxes).
• You must be a legal resident of the United States.
If eligibility is met, you HSA will be opened automatically.
CDHP How the CDHP w/HSA Works;
• Preventive Service – Covered at 100%.
• Injury or Illness at Tier 1 or Network Provider – The amount you pay will be determined after BCBS-discounted
rates.
• Calendar year deductible – After you meet the deductible, the plan will pay 80% of covered services for Tier 1 and
70 percent for Network Providers.
• Out-of-Pocket-Maximum – After you meet the out-of-pocket-maximum, the plan pays 100% for all eligible
covered medical and pharmacy expenses.CDHP w/HSA Schedule of Benefits
Medical Benefits CDHP (Blue Choice PPO) Out-of-Network
Tier 1 Providers Network
Deductible $1,500 - Employee Only $3,000 - Employee Only
$3,000 - Employee & Dependents $6,000 - Employee & Dependents
Preventive Services Member pays $0. Member pays 40% after deductible.
Eligible Covered Member pays Member pays Member pays 40% after deductible.
Services 20% after 30% after
& Facilities deductible. deductible.
Out-of-Pocket $5,000 - Employee Only $10,000 - Employee Only
Calendar Year $6,850 - Employee & Dependents $20,000 - Employee & Dependents
Primary Care
PCP selection is not required.
Physician (PCP)
Referrals Required No. A referral is not required to seek services from a Specialist.
Approximately $49 for general health,
Virtual Visit Copay $100 per session for therapy counseling, Not applicable.
and $175 per session for psychiatry.
Hearing Aids Not covered. For discounts, visit Blue365 at blue365deals.com/bcbstx.
Tier 1 Providers – Providers designated as providing higher quality of care and cost efficiency.
CDHP Vision Benefits
Routine Vision Eye Exam CDHP (Blue Choice PPO) Out-of-Network
Optometrists Member pays 20% after deductible. Member pays 40% after deductible.
Ophthalmologists Member pays 20% after deductible. Member pays 40% after deductible.
Frames, Standard Lenses, Not covered. For discounts, visit Not covered. For discounts, visit
and Contact Lenses Blue365 at blue365deals.com/bcbstx. Blue365 at blue365deals.com/bcbstx.
CDHP Pharmacy Benefits
Plan Features (In-Network) CDHP (Blue Choice PPO)
Affordable Care Act (ACA) Preventive Drug Member pay $0 no deductible.
Li
CDHP w/HSA Preventive Drug List Member pays 20% no deductible.
Basic Drug List - Tier 1, 2 & 3 Member pays 20% after deductible.
90-Day Supply - Mail Order Member pays 20% after deductible.
Pharmacy Drug Lists can be found at bcbstx.com/coa.PPO & HMO Schedule of Benefits
PPO (Blue Choice PPO) HMO (Blue Essentials)
Tier 1 Providers Network Providers Tier 1 Providers Network Providers
Individual
Deductible $600 per covered person. None.
Family
Deductible Three individual deductibles. None.
Maximum
Out-of- pocket
$4,250 per covered person or $13,250 per $4,750 per covered person or $9,500 per family,
Maximum
family, per calendar year. per calendar year.
Provider Selection Members may select Tier 1, Network, or Out- Members must select Tier 1 or Network
of-Network Providers. Providers. Referrals are required from your
PCP to seek services outside of your PCP
including Specialist.
No benefits coverage without a referral.
Primary Care PCP selection is required. If a PCP is not
Physician (PCP) selected, one will be assigned. You will be
required to seek services from the assigned
PCP selection is not required. PCP. To change your PCP, call BlueCross
BlueShield. You may change your PCP on
a monthly basis. The change is effective the
first day of the following month.
Referrals Required No. A referral is not required to seek services Yes. A referral is required to seek services
from a Specialist. from a Specialist. No benefits coverage
without a referral.
Residency Must receive services in Bastrop, Blanco,
Requirements Burnet, Caldwell, Hays, Travis, or Williamson
None. counties.
No benefits coverage outside of this area.
Out-of-Network $2,000 deductible per covered person. None, except in case of a medical emergency.
Benefits Member pays 40%, up to maximum allowable
charge. Out-of-network benefits are subject to
network benefit plan limits, pre-approval, and
pre-notification requirements.
Inpatient Admission are subject to a $500
copay per admission.PPO & HMO Schedule of Benefits
PPO (Blue Choice PPO) HMO – (Blue Essentials)
Tier 1 Providers Network Providers Tier 1 Providers Network Providers
Preventive exams copay $0 $0
Virtual visit copay $10 $10
Office/Telemedicine
visit copay
Primary Care $15 $30 $15 $30
Specialist $30 $50 $40 $60
Convenience care
$25 $25
clinics copay
Urgent care copay $40 $50
Emergency room
$300 $350
copay
Ambulance services Member pays 20% after deductible. $300 copay
Outpatient surgery Member pays 20% Member pays 30%
$750 copay $1,000 copay
after deductible. after deductible.
Inpatient admission Member pays 30%
Member pays 20% $1,750 copay $3,000 copay
after deductible and
after deductible.
$250 copay.
Allergy services Member pays $0 Member pays 50%.
Immunizations Covered in full. Covered in full.
(Office visit copays may apply.) (Office visit copays may apply.)
Physical, speech &
occupational therapy
Registered dietitian $40 $50
Chiropractic care Copay
(20 visit limit)
Acupuncture copay
$40 Not covered.
(12 visit limit)
CT, MRI, PET scans
$100 $150
copay
Mental health care
$15 $15
outpatient copay
Durable medical
Member pays 20% after deductible. Member pays $0.
equipment
Disposable medical
supplies & prosthetic- Member pays 20% after deductible. Member pays 20%.
orthotic devices
Insulin pumps copay $100 $150
Not covered. For discounts, visit Blue365 at
Hearing aids One pair every 48 months.
blue365deals.com/bcbstx
Other covered
Refer to your Medical Plan Document or contact BlueCross BlueShield.
medical expensesPPO & HMO Vision Benefits
Routine Vision Exam PPO (Blue Choice PPO) HMO (Blue Essentials)
Optometrists $25 $25
Ophthalmologists $35 $45
Frames, Standard Lenses, and Not covered. For discounts, Not covered. For discounts,
Contact Lenses visit Blue365 at visit Blue365 at
blue365deals.com/bcbstx. blue365deals.com/bcbstx.
PPO & HMO Prescription Benefits
Plan Features (In-Network) PPO (Blue Choice PPO) HMO (Blue Essentials)
Affordable Care Act $0 copay. $0 copay.
(ACA) Preventive Drugs
$50 annual deductible applies to $50 annual deductible applies to
Deductible
Tier 2 & Tier 3 drugs. Tier 2 & Tier 3 drugs.
Basic Drug List - Tier 1 (Generic) $10 copay. $10 copay.
Basic Drug List - Tier 2 (Preferred) Tier 2: $40 or 20% of cost Tier 2: $45 or 20% of cost
(up to $70). (up to $80).
Tier 3: $60 or 20% of cost Tier 3: $65 or 20% of cost
Basic Drug List - Tier 3 (Non-preferred)
(up to $110). (up to $120).
90-Day Supply - Mail Order 2 x's Tier 1, 2, or 3 copay. 3 x's Tier 1, 2, or 3 copay.
CDHP w/HSA, PPO, and PPO
Diabetic Supplies (see also Diabetic Equipment)
Retail Supplies are covered at a participating pharmacies.
Mail Order Copays for insulin needles/syringes and/or diabetic supplies are waived when dispensed on
the same day as your insulin and oral agents, but only when the insulin or oral agent is
dispended first.
Diabetes Program/Drugs
A participant can receive approved diabetes medication and supplies for free if the participant is covered under a
City sponsored medical plan, at least 18 years of age, and completes requirements of the HealthyConnections
Diabetes Program.
Tobacco Cessation Program/Drugs
A participant can receive FDA-approved tobacco-cessation drugs for free if the participant is covered under a City
sponsored medical plan, at least 18 years of age, and completes requirements of the HealthyConnections Tobacco
Cessation Program. Must obtain a prescription for tobacco cessation drugs from your physician.
This applies to prescription tobacco cessation drugs and over-the-counter nicotine replacement therapy (patches, gums,
etc.) at a retail pharmacy or through the mail order service.Using Mail Order
To begin using mail order:
• Have your doctor write a prescription for a 90-day supply of your medication (ask for three refills).
• Complete the mail order form and attach your prescription.
• Provide a check or credit card information.
• Within 10 days, your prescription will be delivered to you, postage paid.
If your doctor allows you to take a generic drug, this should be indicated on the prescription. Three weeks before your mail
order supply runs out, you will need to request a refill.
Your cost
• CDHP w/HSA participants will pay 20% of the cost once the in-network deductible is met. If you have not met your in-
network deductible, you will pay 100% of the cost. If the prescription is for a preventive care medication listed on the
Expanded Preventive Drug List, no deductible is required and you will only pay 20% of the cost.
• PPO participants receive 90 days of medication for two copays/coinsurance.
• HMO participants receive 90 days of medication for three copays/coinsurance.
For additional information, go to bcbstx.com/coa or call BlueCross BlueShield at 888-907-7880.
Diabetic Bundling – What Your Medical Plan Does for You
A participant's insulin/non-insulin medication and related diabetic supplies can be purchased through mail order for the cost
of the insulin/non-insulin if prescriptions for the insulin/non-insulin and supplies are submitted at the same time.
• CDHP w/HSA participants will pay 20% of the cost once the in-network deductible is met. You can use your HSA
Bank debit card to pay for your out-of-pocket expenses.
• PPO participants will pay two copays/coinsurance for a 90-day prescription.
• HMO participants will pay three copays/coinsurance for a 90-day prescription.
Enroll in the Diabetes Program to receive select Tier 1 diabetes medication and supplies at no cost. This benefit is available
to all participants 18 years of age and older enrolled in a City medical plan. See the Wellness section of this Guide for
details.
H-E-B Prescription Delivery Service
Free prescription delivery is available to your home in the
following Texas areas: Austin, San Antonio, Waco, Houston,
Corpus Christi, and the Border areas within 10 miles of an H-E-B
store.
How does it work?
• Call your H-E-B Pharmacy and ask for prescription delivery.
• Pay the applicable prescription copay/coinsurance by a credit card, debit card, or your FSA/HSA debit card.
• Have someone 18 years or older at home to sign for the delivery.
• Provides delivery of prescriptions filled Monday—Friday by 4 pm, except for major holidays.
• Delivers medications as late as 8 pm.
For more information, call your local H-E-B Pharmacy.Medical Programs Cancer Support Program – Specialized cancer nurses offer needed support to participants throughout cancer treatment, recovery and at end of life to assist with treatment decisions and improve a participant’s health care experience. Experienced, caring cancer nurses from the cancer support program are available to support participants in several ways. They can: • Find the right doctor for you, explore your treatment options and help you manage symptoms and side effects. • Explain your medications. • Work with your doctors to make sure all your questions are answered and inform them about how you’re feeling. • Talk to your spouse, family, children and employer. Comprehensive Kidney Program – Specialized nurses offer education, motivation and reinforcement to ensure integration with other programs. BlueCross BlueShield offers access to the top-performing centers through their network of preferred dialysis centers. You’ll also receive ongoing clinical expertise and help from specialized nurses who can help you: • Understand your treatment options. • Manage your symptoms and side effects. • Work with your doctor and ask the right questions. • With other health concerns, such as high blood. 24/7 NurseLine Services – Coping with health concerns on your own can be tough. With so many choices, it can be hard to know whom to trust for information and support. 24/7 NurseLine services were designed specifically to help you get more involved in your own health care, and to make your health decisions simple and convenient. They will provide you with: • Immediate answers to your health questions anytime, anywhere – 24 hours a day, 7 days a week. • Access to experience registered nurses. • Trusted, physician-approved information to guide your health care decisions. When you call, a registered nurse can help you: • Discuss your options for the right medical care and assist you in guiding you to the correct treatment facility (i.e., Urgent Care, Emergency Room, etc.) • Help you understand treatment options. • Ask medication questions. Call 24/7 NurseLine services any time for health information and support – at no additional cost. Registered nurses are available any time, day or night. Call NurseLine services at 800-581-0368. Virtual Visits -MD LIVE Talk to a board-certified physician for both general health and behavioral health services from the comfort of your home or work. There’s no driving, no crowded waiting rooms, and its available 24 hours a day, 7 days a week. Common services include, cold/flu, allergies, asthma, sinus/ear infections, and pink eye. Behavioral health conditions treated include, online counseling, child behavior/learning issues, and stress management. For the PPO and HMO Plan, virtual visits are a $10 copay for general or behavioral health. For the CDHP Plan, virtual visits are approximately $49 for general health, $100 per session for therapy counseling, and $175 per session for psychiatry. Log in to bcbstx.com/coa or download the BCBSTX app on your smartphone to access Virtual Visits powered by MDLIVE. You will need your BlueCross BlueShield medical ID number and your banking/credit card information readily available to charge your copay. If you have questions please call BlueCross BlueShield at 888-907-7880.
The City of Austin considers health and wellbeing a top priority and supports employees and family members on their
journey to health and happiness. HealthyConnections, the City's award-winning employee wellness program, offers a wide
range of wellness activities to encourage and support a healthy lifestyle. Programs are free to employees and held at various
City worksites. Temporary employees enrolled in a medical plan can earn up to $150 in Healthy Rewards per year.
With your supervisor’s approval, you may be able to attend wellness activities on work time or use flex time to make up
the time later in the week.
Get Engaged in Wellness
Visit the HealthyConnections website on CitySpace for more information and links to register. For questions, call
512-974- 3284 and ask to speak with a Wellness Consultant or email HealthyConnections@austintexas.gov.
Health Care Clinics
HealthyConnections has partnered with Premise Health to bring you onsite & mobile health care clinics. Employees
enrolled in a City medical plan can access the health care clinics for biometric and preventive screenings, immunizations,
and for treatment of minor, non-worker’s compensation injury or illness. The onsite health clinic is located at the Learning
& Research Center at 5202 E Ben White Blvd, Suite 500. The mobile health clinic rotates weekly between various City
worksites. To schedule an appointment call 512-640-4997 or create an account at mypremisehealth.com.
Healthy Rewards Wellness Incentive Program
Healthy Rewards is a financial incentive program designed to engage employees in HealthyConnections campaigns and
improve overall health status. Employees can participate in a variety of activities to earn up to $150 (taxable) added to
their mid-November paycheck.
Visit the HealthyConnections website on CitySpace to see a list of eligible wellness activities and preventive screenings.
To Earn Healthy Rewards
• You must be enrolled in a City-sponsored medical plan.
• You must be employed by the City at the time of November payout.
• You must complete the health assessment between January 1 and September 30.
Know Your Health Numbers Campaign
Know your health numbers and prevent diseases like obesity, diabetes, hypertension, and heart disease.
Health Assessment:
Step 1: Get your Health Numbers at a City Health Screening or your Annual Physical
• To register for a free biometric Health Screening at City a worksite, call 512-974-3284 or visit the
HealthyConnections website on CitySpace. Complete schedule posted on the HealthyConnections website.
OR
• Use lab results from your most recent annual physical through your doctor.
Step 2: Complete the Health Assessment at bcbstx.com/coa.
Get a snapshot of your health, identify risk factors and create a game plan to a healthier you.
• Use your health numbers to complete the BlueCross BlueShield online Health Assessment.
• No personal health information is shared with the City.
• The online Health Assessment must be completed by September 30.Get Active Campaign Engage in heart healthy exercise that can prevent obesity, lower blood pressure and reduce stress. PE for ME – HealthyConnections offers free exercise classes at City worksites to help employees improve their fitness and overall health. The program is offered year round and includes around 80 different classes each quarter. Examples include yoga, strength training, spin classes, Zumba, boot camps, basketball, and more. There are also several Run/Walk classes including an structured running class that can help you train for an upcoming race event. Classes are offered on a quarterly basis, and registration can be accessed through the HR Portal at hrportal.coacd.org/login.cfm. During quarter four, t-shirts will be given to employees who meet attendance requirements. PE Anytime allows employees to track their exercise via the Map My Fitness app or Garmin/Fitbit fitness tracker and earn PE WADL. Camp Gladiator and Orange Theory Fitness members can earn PE credit for attending classes. This option offers flexibility for individuals with challenging schedules or those wanting to exercise on their own. City of Austin Olympics – Earn Healthy Rewards Form teams with your coworkers and compete in a Spring sports tournament including softball, basketball, kickball, sand volleyball and disc golf. Other events include a 5k, Kids 1K, organized bike ride, horse shoes, washers, and obstacle course. Attendees can visit healthy vendors, learn about Wellness & Benefits programs, and enjoy concessions. Virtual Fitness Challenges – Earn Healthy Rewards Employees can participate in month long virtual fitness challenges to get moving toward better health and fitness. Completing at least 30 miles of exercise during a challenge will earn employees $25 in Healthy Rewards. • Million Mile Month in April • Triathlon in a Month in July • Fall into Action in September Race Events The PE Program sponsors employee entry into multiple race events per year. Join the PE Program and learn about race sponsorships including the Cap10K, Zilker Relays, and other events. Heart Walk – Earn Healthy Rewards Join your coworkers for a one-mile Heart Walk and heart health presentation at the February Health & Lifestyle Expo. Live Healthy Campaign Make healthy lifestyle changes that improve health and wellness and prevent chronic diseases. Diabetes Control Program – Receive Diabetes Meds and Supplies at No Cost Learn how to manage your diabetes, get personalized diabetes care, and receive approved diabetes medications and testing supplies at no cost. This program is offered to employees, retirees, and dependents who are diabetic or prediabetic and enrolled in a City-sponsored medical plan. To enroll, visit the HealthyConnections website on CitySpace or call 512-974-3284. Participants Receive: • Approved diabetes medications and testing supplies at no cost • Comprehensive diabetes education • Quarterly screenings through a pharmacist (three visits per year required)
Maternity Support Program and Family Connects Program This program is offered by BlueCross BlueShield and is available to pregnant, covered members enrolled in a City medical plan. The program is designed to provide the support and information needed for a healthy pregnancy. Participants will receive personalized maternity care and assistance in managing high-risk conditions including gestational diabetes and preeclampsia. If you enroll during the first 18 weeks of your pregnancy and complete the program, you will receive $100 in your paycheck (taxable) and a HealthyConnections onesie. To enroll, call BlueCross BlueShield at 888-907-7880. Participants of the Maternity Support program will also be referred to the Family Connects program through Austin Public Health. Family Connects offers in-home consultations with Registered Nurses to identify needs and connect families with available resources. City Flu Shot Clinics – October & November Employees can receive a free quadrivalent flu shot at participating City worksites and the September Health & Lifestyle Expo. View the HealthyConnections website on CitySpace for a complete schedule of City Flu Shot Clinics. City Mammo Mixers – August Don’t put off getting your mammogram any longer. Get a free mammogram at St. David’s Breast Center and enjoy breakfast or lunch and a chair massage while you wait. To make an appointment, call the Breast Center at St. David’s Medical Center at 512-544-8800. Registration will open one month prior to the start of the Mammo Mixers. Tackle Stress from Your Desk – Earn Healthy Rewards Employees can view online webinars that teach simple strategies to prevent and manage stress. Healthy Back and Neck Seminars – Earn Healthy Rewards Attend interactive seminars addressing back and neck pain caused by prolonged sitting and repetitive movements in the workplace. Participants will learn about foam rolling, dynamic stretches, and strengthening exercises to reduce back and neck pain. Financial Wellness – Earn Healthy Rewards Take charge of your personal finances by attending a HealthyConnections Financial Wellness seminar. A variety of seminars led by financial professionals will be offered year-round with something for everyone. You can learn what a budget is, how to reduce your risk of identity theft, how to get a credit report, steps to take to get out of debt and much more. Health and Lifestyle Expos – February & September Visit healthy vendors and learn about City Wellness and Benefits programs. Biometric health screenings are provided along with flu shots in the fall. Tobacco Cessation 101 – Receive Cessation Medications Gain the resources and support needed to quit using tobacco products. Tobacco Cessation program is available on-demand online by webinar or by one-on-one telephonic coaching. Individuals who complete the program are eligible to receive cessation medication (including over-the-counter products) free for nine months with a doctor’s prescription. Employees, spouses and eligible dependents (age 18 years and older) who are enrolled in a City medical plan are eligible for this benefit. Check the HealthyConnections website for more information. Tobacco Premium Employees and spouses/domestic partners currently using tobacco products, including but not limited to cigarettes, cigars, chewing tobacco, snuff, pipes, snus, shisha and electronic cigarettes will be charged a tobacco premium. Employees and spouses/domestic partners enrolled in a City medical plan who use tobacco will each pay $12.50 per pay period. To stop the tobacco premium, employees and spouses using tobacco must complete the Tobacco Cessation 101 class. The scheduled classes can be found on austintexas.gov/benefits. Spouses/domestic partners can attend a class without registering.
Eat Well Campaign Learn heart healthy eating habits and simple strategies that can lead to a healthier you. Wondr Online Weight Management Program This simple, online program helps employees lose weight and improve their health. It’s not a diet. There are no points to count, no starving, and no eating diet food! The program teaches participants when and how to eat the foods they love while losing weight, boosting their energy and improving their health. By learning new techniques about how and when you should eat, you can continue eating your favorite foods while improving your health, reducing your chance of developing chronic disease, and losing weight. To enroll, call HealthyConnections at 512-974-3284 and ask to speak to a Wellness Consultant. Nutritional Counseling Supporting wellness in the workplace. Our Health Coaches can meet with employees one-on-one in person or virtually to provide nutritional counseling. Get assistance with setting appropriate health and fitness goals, identifying barriers to success, and maintaining motivation along the way. Weight reduction, improving nutrition, and managing stress are examples of issues that can be addressed through nutritional counseling. Visit the HealthyConnections website to set up an appointment.
Employee Assistance Program (EAP) ComPsych GuidanceResources® services provides short-term confidential counseling to help you and members of your household deal with life’s stresses. The EAP provides resources to help you address a wide variety of issues. Services are available 24 hours a day, seven days a week at no cost to you. Your EAP benefits will give you and the members of your household confidential support, resources, and information for personal and work-life issues. ComPsych GuidanceResources® can help you with: • Marital/family problems • Work/vocation issues • Stress, Anxiety & Depression • Domestic violence • Grief & Loss • Psychological issues ComPsych Guidance Resources can also assist with work/life issues such as: • Legal Guidance – Including a free 30-minute • Child/elder care referral consultation • Home repair • Financial Guidance • Online Support and more Go Mobile! Access your GuidanceResources® program anytime, anywhere! The GuidanceNowSM app gives you fast, easy access to Employee Assistance Program resources. Check it out! Download the app from your smartphone or tablet. • Search GuidanceResources (one word) • Install GuidanceNow • To register, click the Register link. Enter austintexas.gov as the Organization Web ID. Commuter Program As part of the Clean Air Initiative, the City has an agreement with Capital Metro for the following benefits: Bus and Rail Services City employees can ride any Capital Metro bus or train for free using a transit pass. These passes are available from your department's HR representative. Employees must commit to riding the bus or train on a regular basis. Visit capmetro.org and use the online Trip Planner to learn the easiest and fastest way to commute. RideShare Vanpools City employees can also take advantage of Capital Metro’s vanpool services. Call the Rideshare office at 512-477-RIDE (7433) and get matched to a vanpool operating between your home and work location. Employees also have the option of forming their own vanpool. MetroAccess – Paratransit Services The MetroAccess program serves employees with disabilities by providing shared-ride, door-to-door public transportation service for free. For more information, call Capital Metro at 512-474-1200. "Pickup" On-Demand Transit Service This service allows employees with current City of Austin transit passes to be picked up from their home and taken anywhere within the Pickup service area. For more information, visit capmetro.org/pickup. For more information on the Capital Metro’s program, call Capital Metro at 512-474-1200 or the Employee Benefits Division at 512-974-3284.
Sick Leave
Temporary and Seasonal employees are eligible to receive paid sick leave. Paid sick leave can be used as it is earned, up to
the annual maximum. Any unused sick leave hours will carry over year to year. See chart below for Accrual information.
Hours Worked Per Week Accrued Hours Annual Maximum Hours
Full-Time – 40 hours 3.00 72.00
More than or equal to 30; less than 40 3.00 54.00
More than or equal to 20; less than 30 2.00 36.00
Less than 20 1.00 18.00
Employee Discount Page – PerksConnect
You can save at thousands of retailers in your neighborhood and around the country. Whether it is the local show & save
program, discounted gift cards or national deals, savings are just a click away. Visit austintx.perksconnection.com on your
computer, tablet or smartphone. If you are registering with a tablet or smartphone, enter group code AUSTINTX.
Affordable Small Dollar Loans
Employees have access to affordable small dollar loans and free one- on-one financial coaching through the Community
Loan Center (CLC) of Austin. Apply online at clcofaustin.org, no credit check requirements! For additional customer
service assistance call 956-356-6600 or 214-688-7456.
• Loans range from $400-$1000.
• 12 month terms based on your payroll schedule at 18 percent interest rate.
• One-time $20.00 loan processing fee and easy to use online account management profile.
• No pre-payment penalty fees. Payments can be deducted from your paycheck or drafted from your checking account.
• One-on-one financial coaching at no cost.
• Benefit Eligibility requirements include over 90 days of employment, minimum 18 years of age and a checking account.
Homebuyer Assistance Program
The Housing and Planning Deparatment (HPD) manages programs with area home builders and non-profit agencies to help
eligible employees achieve home ownership, including education and down payment assistance. For more information, call
HPD at 512-974-3100 or email HPD@austintexas.gov.
Other Benefits
• Tax Preparation Assistance, if eligible. Go to foundcom.org.
• Free entry to City parks, including Deep Eddy and Barton Springs pools (does not include Zilker Botanical Gardens).
• Free parking permits to Zilker Park are available at the Human Resources and Parks Departments.Important Benefits
Information
• Summary of Benefits and Coverage
• ADA Compliance
• Governing Plan
• HIPAA
• Women's Health and Cancer Rights Act
• Patient Protection and Affordable Care Act
• COBRA
• Continuation of Coverage for Domestic
Partners
• USERRA Continuation of Coverage
• Your Prescription Drug Coverage and
Medicare
• Health Insurance MarketplaceSummary of Benefits and Coverage (SBC) Under the law, insurance companies and group health plans must provide consumers with a concise document detailing, in plain language, simple and consistent information about health plan benefits and coverage. This summary will help consumers better understand the coverage they have and allow them to easily compare different coverage options. It summarizes the key features of the plan and coverage limitations and exceptions. For a copy of the SBC of the City's medical plans, go to austintexas.gov/benefits or call 512-974-3284. ADA Compliance The City is committed to complying with the Americans with Disabilities Act (ADA). Reasonable accommodation, including equal access to communications, will be provided upon request. For more information, call the Human Resources Department at 512-974-3284, use the Relay Texas TTY number 800-735-2989 for assistance, or visit the website at austintexas.gov/ada. Governing Plan Your rights are governed by each plan instrument (which may be a plan document, evidence of coverage, certificate of coverage or contract), and not by the information in this Guide. If there is a conflict between the provisions of the plan you selected and this Guide, the terms of the plan govern. City of Austin employees have access to benefits approved by the City Council each year as part of the budget process. The benefits and services offered by the City may be changed or terminated at any time. These benefits are not a guarantee of your employment with the City. The Health Insurance Portability & Accountability Act of 1996 (HIPAA) This act imposes the following restrictions on group health plans: Limitations on pre-existing exclusion periods. Pre- existing conditions can only apply to conditions for which medical advice, diagnosis, care, or treatment was recommended or received during a period beginning six months prior to an individual’s enrollment date, and any pre-existing condition exclusion is not permitted to extend for more than 12 months after the enrollment date. Further, a pre-existing condition exclusion period may be reduced by any creditable previous coverage the individual may have had. Special enrollment. Group health plans must allow certain individuals to enroll upon the occurrence of certain events, including new dependents and loss of other coverage. Loss of coverage includes: • Termination of employer contributions toward other coverage. • Moving out of an HMO service area. • Ceasing to be a “dependent,” as defined by the other plan. • Loss of coverage to a class of similarly situated individuals under the other plan (i.e., part-time employees). Additionally, individuals entitled to special enrollment must be allowed to enroll in all available benefit package options and to switch to another option if he or she has a spouse or dependent with special enrollment rights. Prohibitions against discriminating against individual participants and beneficiaries based on health status: Plans may not establish rules for eligibility of any individual to enroll under the terms of the plan based on certain health status- related factors, including health status, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability or disability. Standards relating to benefits for mothers and newborns: Plans must provide for a 48-hour minimum stay for vaginal childbirth, and a 96-hour minimum stay for cesarean childbirth, unless the mother or medical provider shortens this period. No inducements or penalties can be used with the mother or medical provider to circumvent these rules. Parity in the application of certain limits to mental health benefits: Plans must apply the same annual and lifetime limits (i.e., dollar amounts) that apply to other medical benefits to benefits for mental health. If this requirement results in a one percent or more increase in plan costs or premiums, this rule does not apply.
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